Thrombolysis: Minimally invasive method for clearing/dissolving intravascular thrombus
IV thrombolysis delivers systemic dose of medication designed to promote fibrinolysis
Most commonly used form of thrombolysis
Tissue plasminogen activator (tPA) most frequently used thrombolytic drug
Direct intravascular thrombolysis requires placement of catheter/device into thrombosed vessel
May place either intraarterially or intravenously
Localized treatment of thrombosed target vessel
Thrombectomy: Removal of acute or chronic thrombus without use of thrombolytic medications
Catheter-directed thrombolysis (CDT): Infusion of thrombolytic agent via percutaneously placed catheter
Delivers concentrated dose to thrombosed vessel
May be intraarterial or IV
Mechanical thrombectomy (MT): Fragmentation/aspiration/coring of thrombus using intravascular medical device
Mechanism of action dependent on device: Macerates clot into macro-/microscopic debris, or aspirates whole thrombus via large-bore catheter
Rapid, single session treatment
May be appropriate for patients with contraindication to thrombolytics
Pharmacomechanical thrombolysis (PCDT): Use of combined mechanical device and thrombolytic agent
Increases thrombus surface area in contact with thrombolytics
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Expected Outcomes
Selected References
Buckley JR et al: In-hospital mortality and related outcomes for elevated risk acute pulmonary embolism treated with mechanical thrombectomy versus routine care. J Intensive Care Med. 37(7):877-82, 2022
Ahmed O et al: Meta-analysis of the usefulness of inferior vena cava filters in massive and submassive pulmonary embolism. Am J Cardiol. 128:54-9, 2020
Pei DT et al: Meta-analysis of catheter directed ultrasound-assisted thrombolysis in pulmonary embolism. Am J Cardiol. 124(9):1470-7, 2019
Wible BC et al: Safety and efficacy of acute pulmonary embolism treated via large-bore aspiration mechanical thrombectomy using the Inari FlowTriever Device. J Vasc Interv Radiol. 30(9):1370-5, 2019
Fleck D et al: Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Ther. 7(Suppl 3):S228-37, 2017
Watson L et al: Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 11:CD002783, 2016
Comerota AJ: Thrombolysis for deep venous thrombosis. J Vasc Surg. 55(2):607-11, 2012
Manninen H et al: Catheter-directed thrombolysis of proximal lower extremity deep vein thrombosis: a prospective trial with venographic and clinical follow-up. Eur J Radiol. 81(6):1197-202, 2012
Karnabatidis D et al: Quality improvement guidelines for percutaneous catheter-directed intra-arterial thrombolysis and mechanical thrombectomy for acute lower-limb ischemia. Cardiovasc Intervent Radiol. 34(6):1123-36, 2011
Kühn JP et al: Intraarterial recombinant tissue plasminogen activator thrombolysis of acute and semiacute lower limb arterial occlusion: quality assurance, complication management, and 12-month follow-up reinterventions. AJR Am J Roentgenol. 196(5):1189-93, 2011
Popuri RK et al: The role of thrombolysis in the clinical management of deep vein thrombosis. Arterioscler Thromb Vasc Biol. 31(3):479-84, 2011
Schrijver AM et al: Dutch randomized trial comparing standard catheter-directed thrombolysis versus ultrasound-accelerated thrombolysis for thromboembolic infrainguinal disease (DUET): design and rationale. Trials. 12:20, 2011
Wicky ST: Acute deep vein thrombosis and thrombolysis. Tech Vasc Interv Radiol. 12(2):148-53, 2009
Semba CP et al: Thrombolysis for lower extremity deep venous thrombosis. Tech Vasc Interv Radiol. 7(2):68-78, 2004
Semba CP et al: Alteplase as an alternative to urokinase. Advisory Panel on Catheter-Directed Thrombolytic Therapy. J Vasc Interv Radiol. 11(3):279-87, 2000
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Preprocedure
Procedure
Outcomes
TERMINOLOGY
Definitions
Thrombolysis: Minimally invasive method for clearing/dissolving intravascular thrombus
IV thrombolysis delivers systemic dose of medication designed to promote fibrinolysis
Most commonly used form of thrombolysis
Tissue plasminogen activator (tPA) most frequently used thrombolytic drug
Direct intravascular thrombolysis requires placement of catheter/device into thrombosed vessel
May place either intraarterially or intravenously
Localized treatment of thrombosed target vessel
Thrombectomy: Removal of acute or chronic thrombus without use of thrombolytic medications
Catheter-directed thrombolysis (CDT): Infusion of thrombolytic agent via percutaneously placed catheter
Delivers concentrated dose to thrombosed vessel
May be intraarterial or IV
Mechanical thrombectomy (MT): Fragmentation/aspiration/coring of thrombus using intravascular medical device
Mechanism of action dependent on device: Macerates clot into macro-/microscopic debris, or aspirates whole thrombus via large-bore catheter
Rapid, single session treatment
May be appropriate for patients with contraindication to thrombolytics
Pharmacomechanical thrombolysis (PCDT): Use of combined mechanical device and thrombolytic agent
Increases thrombus surface area in contact with thrombolytics
PREPROCEDURE
Indications
Contraindications
Preprocedure Imaging
Getting Started
PROCEDURE
Procedure Steps
Findings and Reporting
Alternative Procedures/Therapies
POST PROCEDURE
Things to Do
OUTCOMES
Complications
Expected Outcomes
Selected References
Buckley JR et al: In-hospital mortality and related outcomes for elevated risk acute pulmonary embolism treated with mechanical thrombectomy versus routine care. J Intensive Care Med. 37(7):877-82, 2022
Ahmed O et al: Meta-analysis of the usefulness of inferior vena cava filters in massive and submassive pulmonary embolism. Am J Cardiol. 128:54-9, 2020
Pei DT et al: Meta-analysis of catheter directed ultrasound-assisted thrombolysis in pulmonary embolism. Am J Cardiol. 124(9):1470-7, 2019
Wible BC et al: Safety and efficacy of acute pulmonary embolism treated via large-bore aspiration mechanical thrombectomy using the Inari FlowTriever Device. J Vasc Interv Radiol. 30(9):1370-5, 2019
Fleck D et al: Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc Diagn Ther. 7(Suppl 3):S228-37, 2017
Watson L et al: Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev. 11:CD002783, 2016
Comerota AJ: Thrombolysis for deep venous thrombosis. J Vasc Surg. 55(2):607-11, 2012
Manninen H et al: Catheter-directed thrombolysis of proximal lower extremity deep vein thrombosis: a prospective trial with venographic and clinical follow-up. Eur J Radiol. 81(6):1197-202, 2012
Karnabatidis D et al: Quality improvement guidelines for percutaneous catheter-directed intra-arterial thrombolysis and mechanical thrombectomy for acute lower-limb ischemia. Cardiovasc Intervent Radiol. 34(6):1123-36, 2011
Kühn JP et al: Intraarterial recombinant tissue plasminogen activator thrombolysis of acute and semiacute lower limb arterial occlusion: quality assurance, complication management, and 12-month follow-up reinterventions. AJR Am J Roentgenol. 196(5):1189-93, 2011
Popuri RK et al: The role of thrombolysis in the clinical management of deep vein thrombosis. Arterioscler Thromb Vasc Biol. 31(3):479-84, 2011
Schrijver AM et al: Dutch randomized trial comparing standard catheter-directed thrombolysis versus ultrasound-accelerated thrombolysis for thromboembolic infrainguinal disease (DUET): design and rationale. Trials. 12:20, 2011
Wicky ST: Acute deep vein thrombosis and thrombolysis. Tech Vasc Interv Radiol. 12(2):148-53, 2009
Semba CP et al: Thrombolysis for lower extremity deep venous thrombosis. Tech Vasc Interv Radiol. 7(2):68-78, 2004
Semba CP et al: Alteplase as an alternative to urokinase. Advisory Panel on Catheter-Directed Thrombolytic Therapy. J Vasc Interv Radiol. 11(3):279-87, 2000
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